Metabolic and magnetic resonance imaging: complementary modalities for the preoperative assessment of lateral pelvic lymph nodes in rectal cancer

Cribb, BI; Kong, JC; Kay, JS; Tan, TH; Noe, GD; Gest, B; Lee, AB; Oon, SF; Warrier, SK; Heriot, AG

Author(s): Cribb, BI; Kong, JC; Kay, JS; Tan, TH; Noe, GD; Gest, B; Lee, AB; Oon, SF; Warrier, SK; Heriot, AG;
Details: Publication Year 2023-01,Volume 93,Issue #1-2,Page 196-205
Journal Title: ANZ Journal of Surgery
Publication Type: Research article
Abstract: BACKGROUND: The management of lateral pelvic lymph nodes for rectal cancer is a topical and controversial issue. The aim of this study was to assess the relationship between lateral pelvic lymph node features on magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET-CT) with oncological outcomes in patients with rectal cancer. METHODS: A retrospective analysis of 284 patients with primary locally advanced rectal cancer treated with neoadjuvant therapy and surgical resection with curative intent between January 2003 and Dec 2018 was undertaken. From this study population, a select cohort of 77 patients with abnormal lateral pelvic lymph nodes on preoperative imaging had imaging re-analysed by radiologists blinded to clinical outcomes. Pre and post neoadjuvant therapy MRI and PET-CT lateral pelvic lymph node features were correlated with oncological outcomes. RESULTS: A lateral pelvic lymph node short axis size >/=5 mm on post neoadjuvant therapy MRI was a significant predictor of worse 3-year local recurrence free survival (HR 8.35, P = 0.001). Lateral pelvic lymph node avidity on post neoadjuvant therapy PET-CT was a significant predictor of worse 3-year distant recurrence free survival (HR 5.62, P = 0.001). No correlation of oncological outcomes with overall survival was identified. CONCLUSION: Lateral pelvic lymph node imaging features on post-neoadjuvant therapy MRI and PET-CT predicted those at risk of rectal cancer recurrence. Further studies are required to confirm these findings that suggest restaging MRI and PET-CT are complementary modalities for the preoperative assessment of lateral pelvic lymph nodes in rectal cancer.
Publisher: Wiley
Keywords: Humans; *Positron Emission Tomography Computed Tomography/methods; Retrospective Studies; Neoplasm Recurrence, Local/pathology; Lymph Nodes/pathology; *Rectal Neoplasms/diagnostic imaging/surgery; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Lymph Node Excision/methods; extended lymphadenectomy; lateral pelvic lymph node dissection; rectal adenocarcinoma
Department(s): Surgical Oncology; Cancer Imaging
PubMed ID: 36074654
Publisher's Version: https://doi.org/10.1111/ans.18020
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2023-04-04 06:09:44

Last Modified: 2024-07-09 05:19:08